Extravasation of liposomal daunorubicin in patients with AIDS-associated Kaposi's sarcoma: a report of four cases.
OBJECTIVE
To report on four patients with AIDS-related Kaposi's sarcoma who were treated with liposomal daunorubicin (DaunoXome, NeXstar Pharmaceuticals, Inc., San Dimas, CA) as part of phase I/II and phase III clinical trials and who experienced extravasation during IV infusion.


RESULTS
All patients were treated with ice as an immediate intervention. In addition, two patients received treatment with multiple subcutaneous injections of steroids. Two patients experienced erythema, swelling, and pain after the extravasation. Two patients who were treated aggressively reported erythema and swelling without pain. Three patients observed changes in the texture of their skin that was accompanied by decreased sensation, which developed after 8-16 weeks. These changes completely resolved in all patients receiving intervention after six months. None of the patients suffered tissue necrosis.


CONCLUSIONS
Extravasation with liposomal daunorubicin is notable for the absence of tissue necrosis that typically is observed with anthracyclines. Long-term effects were limited to skin discoloration and decreased sensation, both of which resolved in all patients.


CONCLUSIONS
The lack of observed skin necrosis with daunorubicin suggests a treatment advantage with a reduction in the required aggressive extravasation procedures for free anthracyclines as well as increased safety for the patient. Additional data is needed to confirm these observations.
Cabriales
S
S
Department of Internal Medicine, University of Southern California (USC) School of Medicine, Los Angeles, USA.
Bresnahan
J
J
Testa
D
D
Espina
B M
BM
Scadden
D T
DT
Ross
M
M
Gill
P S
PS
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects*; D004337:Drug Carriers; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D012514:Sarcoma, Kaposi / Q000188:drug therapy* / Q000821:virology
D000903:Antibiotics, Antineoplastic; D004337:Drug Carriers; D008081:Liposomes; D003630:Daunorubicin